As Americans struggle with rising living costs, a pending court case could add another financial burden for over 150 million people: the price of preventive health care.

The U.S. Supreme Court heard oral arguments Monday in a case against a federal policy that requires health insurers to cover preventive screenings — recommended by an independent health task force — at no cost to patients. Covered services include mammograms, depression and HIV screening, falls prevention, and child immunizations.

If the court strikes down the provision, which is part of the Affordable Care Act, access to preventive care would be stripped away from millions of Americans.

“This means more cancer, more heart disease, more strokes, more complications from pregnancy, more drug misuse, and frankly — more preventable deaths,” APHA Executive Director Georges Benjamin, MD, said in an April 17 news briefing. The Association filed a friend-of-the-court brief with public health deans and other scholars in the case, arguing that life-saving services would be endangered.

In the case, Kennedy v. Braidwood Management, opponents of the law argue that relying on recommendations from the U.S. Preventive Services Task Force, is unconstitutional because experts on the volunteer board are appointed by the U.S. secretary of health and human services, not confirmed by the Senate.

The ACA provision has improved the health of millions of Americans by providing no-cost access to preventive services. In 2018, nearly one-third of Americans with employer-sponsored health insurance received at least one preventive service, according to a study in JAMA Health Forum.

Preventive care plays a critical role in detecting illnesses at an early stage, before they become too advanced to treat effectively. Following the passage of the Affordable Care Act, the incidence of colorectal cancer — a leading cause of death among young people — fell by 17%, and patient outcomes significantly improved, a study in Digestive Diseases and Sciences found.

Overturning the statute would force millions to pay co-pays or out-of-pocket costs for essential services such as vaccinations, statins, cancer screenings, and mental health or substance use counseling. Even very low cost-sharing — between $1 and $5 — has been shown to reduce the use of preventive care, according to a report from KFF.

A negative ruling could lead to fewer adults and children receiving vaccinations, potentially increasing the spread of infectious diseases and worsening ongoing outbreaks, such as the measles outbreak in West Texas.

Regardless of the outcome, the case is expected to reshape the landscape of preventive care in the U.S., said Dorian Mason, director of health equity at the National Women’s Law Center.

One scenario is that the ruling might preserve the current guidelines temporarily but prevent the task force from issuing any new recommendations moving forward. Another possibility is that judges could wipe out all USPSTF recommendations made since 2010.

Some public health experts anticipate a different outcome — one where the HHS secretary sees new opportunity to exert more authority over the USPSTF, including the power to remove members at will and potentially cutting the task force’s funding entirely.

Cuts to — or even elimination — of no-cost preventive services disproportionately harms women, people of color and LGBTQ people, all of whom are more likely to experience higher rates of poverty, lower wages and more financial insecurity.

“We're in a time of economic volatility and public health infrastructure decimation,” Mason said in a press briefing. “Now more than ever, people are concerned about how they're paying rent, how they're paying for groceries, how they're paying for child care, how they're able to access care. This is not the time for market confusion and threats. This is a time to reinforce access to health care and uphold this crucial preventive care provision.”

Photo by Cedric Fauntleroy, courtesy Pexels.